A. Burdorf

The influence of chronic health problems on work ability and productivity at work: a longitudinal study among older employees

OBJECTIVESnThis study aimed to assess the influence of chronic health problems on work ability and productivity at work among older employees using different methodological approaches in the analysis of longitudinal studies.nnnMETHODSnData from employees, aged 45-64, of the longitudinal Study on Transitions in Employment, Ability and Motivation was used (N=8411). Using three annual online questionnaires, we assessed the presence of seven chronic health problems, work ability (scale 0-10), and productivity at work (scale 0-10). Three linear regression generalized estimating equations were used. The time-lag model analyzed the relation of health problems with work ability and productivity at work after one year; the autoregressive model adjusted for work ability and productivity in the preceding year; and the third model assessed the relation of incidence and recovery with changes in work ability and productivity at work within the same year.nnnRESULTSnWorkers with health problems had lower work ability at one-year follow-up than workers without these health problems, varying from a 2.0% reduction with diabetes mellitus to a 9.5% reduction with psychological health problems relative to the overall mean (time-lag). Work ability of persons with health problems decreased slightly more during one-year follow-up than that of persons without these health problems, ranging from 1.4% with circulatory to 5.9% with psychological health problems (autoregressive). Incidence related to larger decreases in work ability, from 0.6% with diabetes mellitus to 19.0% with psychological health problems, than recovery related to changes in work ability, from a 1.8% decrease with circulatory to an 8.5% increase with psychological health problems (incidence-recovery). Only workers with musculoskeletal and psychological health problems had lower productivity at work at one-year follow-up than workers without those health problems (1.2% and 5.6%, respectively, time-lag).nnnCONCLUSIONSnAll methodological approaches indicated that chronic health problems were associated with decreased work ability and, to a much lesser extent, lower productivity at work. The choice for a particular methodological approach considerably influenced the strength of the associations, with the incidence of health problems resulting in the largest decreases in work ability and productivity at work.

Study on Transitions in Employment, Ability and Motivation (STREAM): The Design of a Four-year Longitudinal Cohort Study among 15,118 Persons Aged 45 to 64 Years

The objective of the Study on Transitions in Employment, Ability and Motivation (STREAM) is to acquire knowledge on determinants of transitions in employment and work productivity among persons aged 45-64 years. Research Framework: A research framework was developed, in which transitions in employment (e.g. leaving the workforce, entering the workforce, job change) and work productivity are influenced by the following determinants: health, job characteristics, skills and knowledge, social factors, and financial factors. Central explanatory variables in the framework are the ability to work, the motivation to work, and the opportunity to work. Study Design: STREAM is a prospective cohort study among 12,055 employees, 1,029 self-employed persons, and 2,034 non-working persons, all aged 45 to 64 years at baseline. The study sample was stratified by age and employment status (employed, self-employed, non-working), and was drawn from an existing internet panel. The baseline measurement was carried out in 2010 (response: 70%), and with yearly follow-up measurements in 2011 (response: 82%), 2012 (response: 80%), and 2013. At each wave, participants fill out an online questionnaire covering all aspects of the research framework. Place and Duration of Study: The Netherlands, between October 2010 and December 2013. Methodology: Quantitative data on all aspects of the research framework were assessed with an online questionnaire, qualitative data were assessed with interview studies, and the questionnaire data can be linked to register data at Statistics Netherlands for 89% of the participants. Results: Transitions in employment between the first three waves of data among the participants are described. Conclusion: STREAM will provide insight in the determinants of healthy and productive labour participation among persons aged 45 years and older, which will support the development of interventions prolonging working life in good health, while maintaining good work productivity.

Evaluation of occupational health interventions using a randomized controlled trial: challenges and alternative research designs

Occupational health researchers regularly conduct evaluative intervention research for which a randomized controlled trial (RCT) may not be the most appropriate design (eg, effects of policy measures, organizational interventions on work schedules). This article demonstrates the appropriateness of alternative designs for the evaluation of occupational health interventions, which permit causal inferences, formulated along two study design approaches: experimental (stepped-wedge) and observational (propensity scores, instrumental variables, multiple baseline design, interrupted time series, difference-in-difference, and regression discontinuity). For each design, the unique characteristics are presented including the advantages and disadvantages compared to the RCT, illustrated by empirical examples in occupational health. This overview shows that several appropriate alternatives for the RCT design are feasible and available, which may provide sufficiently strong evidence to guide decisions on implementation of interventions in workplaces. Researchers are encouraged to continue exploring these designs and thus contribute to evidence-based occupational health.

Differential Effects of Mental and Physical Health and Coping Style on Work Ability: A 1-Year Follow-Up Study among Aging Workers

Objective: This study examines whether mental and physical health relate differently to work ability and whether these associations vary with coping style. Methods: A 1-year longitudinal study was conducted among 8842 employees aged 45 to 64 years from the Study on Transitions in Employment, Ability and Motivation. On-line questionnaires measured self-perceived mental and physical health at baseline and coping and work ability at follow-up. The data were analyzed using hierarchical regression analysis. Results: Active coping and good mental and especially physical health predicted high work ability at follow-up. Avoidant coping was negatively related to work ability. Seeking support was unrelated to work ability. Interaction effects of coping and health on work ability were weak. Conclusions: Successful coping styles and good health predict high work ability, and thus, promoting such factors can help improve sustainable employability.

How do Older Employees with Health Problems Remain Productive at Work?: A Qualitative Study

Purpose The goal of this qualitative study was to gain insight into how older employees remain productive at work in spite of health problems. Methods Twenty-six semi-structured telephone interviews were conducted with older employees, 46–63xa0years of age, who reported a poor health in the Study on Transitions in Employment, Ability, and Motivation. Demographic, health, and work information was gathered, followed by information on adjustments made in response to health problems. Inductive and deductive analyses were done independently by two researchers. Results Four pathways through which poor health could influence productivity were identified: (1) poor health did not influence productivity; (2) poor health created a temporary imbalance in demands and external and internal resources after which adjustments were made and productivity was maintained; (3) adjustments were made in response to an imbalance, but productivity remained reduced; and (4) no adjustments were made and productivity was reduced. Whether and which adjustments occurred was influenced by factors in various domains, such as: visibility of the problem (health), autonomy (work-related), support (relational), and the ability to ask for help (personal). Sustainable productivity was influenced by internal factors that enhanced or hindered the creation of a balance, and by whether appropriate adjustments were made. Conclusions The influence that health can have on productivity depends on the individuals’ unique imbalance and personal disposition. Helpful a priori work place characteristics and personal well-being should be promoted so that a balance between demands and resources can be found in times of poor health.

De invloed van gezondheid op vervroegde uittreding uit het arbeidsproces in elf Europese landen

SamenvattingInleiding: Als gevolg van een toenemende levensverwachting en achterblijvende geboortecijfers vergrijst de bevolking in Europese landen. Hierdoor is het belangrijk onderzoek te doen naar de relatie tussen slechte gezondheid en uitval uit de arbeidsmarkt voor verschillende routes van uitval onder oudere werknemers.Methode: Deelnemers aan de ‘Survey of Health, Ageing and Retirement in Europe’ (SHARE) in 2004 en 2006 in de leeftijd van 50 tot 63 jaar en werkzaam tijdens de basismeting werden geselecteerd (n=4585). Vier verschillende metingen van gezondheid werden gebruikt: ervaren algemene gezondheid, chronische ziekte, aanwezigheid van mobiliteitsproblemen en beperkingen in instrumentele dagelijkse activiteiten. Zelfgerapporteerde arbeidsparticipatie werd gecategoriseerd in vijf exclusieve antwoordmogelijkheden: betaalde arbeid, pensioen, werkloos, huisvrouw of arbeidsongeschikt. Logistische regressieanalyse werd gebruikt om het risico van slechte gezondheid op uitval uit de arbeidsmarkt gedurende 2 jaar follow-up te berekenen.Resultaten: Gedurende de 2 jaar follow-up verliet 17% van de werknemers de arbeidsmarkt, hoofdzakelijk als gevolg van pensioen. Slechte gezondheid was sterk geassocieerd met werkloos worden (OR 2,10), pensionering (OR 1,35) en arbeidsongeschikt raken (OR 2,26–4,46), gecontroleerd voor individuele en werkgerelateerde kenmerken. Laag opleidingsniveau (OR 1,63–2,92), gebrek aan controle op het werk (OR 1,22–2,64), lage ‘effort-reward’-balans (OR 1,09–1,58) en obesitas (OR 1,40–1,91) waren risicofactoren voor vervroegde uittreding.Conclusie en beschouwingen: Slechte gezondheid is een belangrijke voorspeller van uitval uit de arbeidsmarkt in deze groep.Gezondheidsmanagement in bedrijven kan dus niet alleen een bijdrage leveren aan een betere gezondheid, maar ook aan een langere inzetbaarheid van het personeel.

Uitvoering van interventieonderzoek in de bedrijfsgezondheidszorg Wat gaat goed, wat kan beter?

samenvattingOnderzoek in de bedrijfsgezondheidszorg is een zaak van vele partijen. Om tot succesvol onderzoek te komen zijn onderzoekers in de bedrijfsgezondheidszorg bijeengekomen om succes- en faalfactoren voor onderzoek in kaart te brengen. De bereidheid voor deelname aan onderzoek in de bedrijfsgezondheidszorg is groot, maar er dient voldaan te worden aan een aantal randvoorwaarden. De belangrijkste randvoorwaarden zijn: aansluiten bij onderzoeksvragen uit de praktijk en bij procedures in de praktijk om extra werkdruk te voorkomen, het aantal onderzoekshandelingen voor de bedrijfsarts en ondersteunend personeel te beperken, tegemoet te komen aan wensen van bedrijfsartsen, ondersteunend personeel en werkgevers, en zorg te dragen voor voldoende financiering van extra handelingen en interventies binnen het onderzoek. Naar aanleiding van de bijeenkomst en naar aanleiding van vergelijkbare ervaringen bij onderzoek binnen de huisartsgeneeskunde is een checklist voor werving van bedrijfsartsen voor deelname aan onderzoek opgesteld.

Determinanten van werkvermogen bij hoger opgeleide professionals

SamenvattingDe arbeidsparticipatie in Nederland moet omhoog. Ouderen, vrouwen en achtergestelde groepen moeten meer aan het werk. Dit advies kreeg het Nederlandse kabinet onlangs van de Europese Commissie. In recent onderzoek zijn drie gebieden geïdentificeerd die samenhangen met verminderde arbeidsparticipatie, te weten; verminderde gezondheid, belastende arbeidsomstandigheden (stress, fysieke belasting) en een ongezonde leefstijl. In een onderzoekspopulatie van 542 hoger opgeleide werknemers (respons 74%) uit zes verschillende bedrijven in de commerciële dienstverlening in Nederland is onderzoek gedaan naar de individuele en werkgerelateerde determinanten van werkvermogen en mentale en fysieke gezondheid.De resultaten van dit onderzoek wijzen erop dat werkvermogen in sterke mate wordt bepaald door dezelfde factoren als mentale gezondheid. Hierbij zijn omgaan met stress en psychosociale werkfactoren, zoals ontplooiingsmogelijkheden, van groot belang. Hoewel het bevorderen van de gezondheid om een langetermijnbenadering vraagt, en er op korte termijn slechts beperkte verbeteringen in gezondheid en daarmee samenhangend het werkvermogen kunnen worden gerealiseerd, wordt aanbevolen in de deelnemende bedrijven te investeren in het bevorderen van psychosociale factoren op het werk en het beter ‘omgaan met stress’.